Provider Demographics
NPI:1740646561
Name:GERDES COUNSELING
Entity type:Organization
Organization Name:GERDES COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GERDES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:208-291-0005
Mailing Address - Street 1:715 HUGHES DR
Mailing Address - Street 2:
Mailing Address - City:PAYETTE
Mailing Address - State:ID
Mailing Address - Zip Code:83661-3037
Mailing Address - Country:US
Mailing Address - Phone:208-291-0005
Mailing Address - Fax:
Practice Address - Street 1:715 HUGHES DR
Practice Address - Street 2:
Practice Address - City:PAYETTE
Practice Address - State:ID
Practice Address - Zip Code:83661-3037
Practice Address - Country:US
Practice Address - Phone:208-291-0005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-08
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID6130101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty